Waldenstrom Macroglobulinemia: Clinical Presentation, Diagnosis, and Management in an Elderly Male

Abstract

Waldenstrom macroglobulinemia (WM) is a rare lymphoproliferative disease that can have an ambiguous clinical presentation. A key component of the pathophysiology of WM is bone marrow infiltration, which most commonly presents as anemia. Other symptoms of WM tend to be generalized and non-specific, which presents a diagnostic challenge. This was the case with our patient as well, when he presented to our outpatient clinic with non-specific symptoms. We present a 79-year-old male with longstanding pancytopenia, polyarthralgia, bilateral pedal edema, decreased appetite, and increased bleeding from wounds. The patient had a complete blood count (CBC) and complete metabolic panel (CMP) done, confirming present anemia, which prompted inpatient treatment and an oncology workup, confirming WM. The patient began a zanubrutinib monotherapy regimen, showing improvement in his pancytopenia, polyarthralgia, and overall symptoms.

Keywords: bone marrow aspirate; bruton tyrosine kinase inhibitor; cxcr4; hyperviscosity syndrome; kappa-lambda ratio; large b-cell lymphoma; monoclonal igm gammopathy; pancytopenia; waldenstrom; waldenstroms macroglobulinemia.

Figure 1. RDW values from distinct hospital visits

Grey bar represents RDW normal range of 11.5% to 14.5% † First time patient presented to the clinic. †† Patient started on Zanubrutinib *Pre-transfusion hospitalization **Visits during which the patient received a blood transfusion RDW: Red cell distribution width